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Sodium bicarbonate-based hydration prevents contrast-induced nephropathy: a meta-analysis.

Meier P, Ko DT, Tamura A, Tamhane U, Gurm HS - BMC Med (2009)

Bottom Line: Former meta-analyses and several recent studies have shown conflicting results regarding the protective effect of sodium bicarbonate.No significant differences in the rates of post-procedure hemodialysis (P = 0.20) or death (P = 0.53) was observed.Sodium bicarbonate-based hydration was found to be superior to normal saline in prevention of contrast-induced nephropathy in this updated meta-analysis.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Michigan School of Medicine, Ann Arbor, Michigan, USA. pmeier@med.umich.edu

ABSTRACT

Background: Contrast-induced nephropathy is the leading cause of in-hospital acute renal failure. This side effect of contrast agents leads to increased morbidity, mortality, and health costs. Ensuring adequate hydration prior to contrast exposure is highly effective at preventing this complication, although the optimal hydration strategy to prevent contrast-induced nephropathy still remains an unresolved issue. Former meta-analyses and several recent studies have shown conflicting results regarding the protective effect of sodium bicarbonate. The objective of this study was to assess the effectiveness of normal saline versus sodium bicarbonate for prevention of contrast-induced nephropathy.

Methods: The study searched MEDLINE, EMBASE, Cochrane databases, International Pharmaceutical Abstracts database, ISI Web of Science (until 15 December 2008), and conference proceedings for randomized controlled trials that compared normal saline with sodium bicarbonate-based hydration regimen regarding contrast-induced nephropathy. Random-effects models were used to calculate summary odds ratios.

Results: A total of 17 trials including 2,633 subjects were pooled. Pre-procedural hydration with sodium bicarbonate was associated with a significant decrease in the rate of contrast-induced nephropathy (odds ratios 0.52; 95% confidence interval 0.34-0.80, P = 0.003). Number needed to treat to prevent one case of contrast-induced nephropathy was 16 (95% confidence interval 10-34). No significant differences in the rates of post-procedure hemodialysis (P = 0.20) or death (P = 0.53) was observed.

Conclusion: Sodium bicarbonate-based hydration was found to be superior to normal saline in prevention of contrast-induced nephropathy in this updated meta-analysis.

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Related in: MedlinePlus

The Forest plot of odds ratios of contrast-induced nephropathy. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Studies are stratified by year of presentation and/or publication. Horizontal bars, 95% confidence interval. NaHCO3 = sodium bicarbonate; NS = normal saline.
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Figure 2: The Forest plot of odds ratios of contrast-induced nephropathy. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Studies are stratified by year of presentation and/or publication. Horizontal bars, 95% confidence interval. NaHCO3 = sodium bicarbonate; NS = normal saline.

Mentions: CIN occurred in a total of 109 patients in the 1,327 patients of the NaHCO3 arms (range 1.4% to 31.0%) compared with 175 such events in the 1,306 subjects treated with NS (range 2.7% to 34.5%) (Table 1). The summary OR was 0.52 (95% CI 0.34–0.81, P < 0.004) (Figure 2) in favor of NaHCO3. The number needed to treat to prevent one CIN was 16 (95% CI 10–34).


Sodium bicarbonate-based hydration prevents contrast-induced nephropathy: a meta-analysis.

Meier P, Ko DT, Tamura A, Tamhane U, Gurm HS - BMC Med (2009)

The Forest plot of odds ratios of contrast-induced nephropathy. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Studies are stratified by year of presentation and/or publication. Horizontal bars, 95% confidence interval. NaHCO3 = sodium bicarbonate; NS = normal saline.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2693108&req=5

Figure 2: The Forest plot of odds ratios of contrast-induced nephropathy. Sizes of data markers are proportional to the weight of each study in the meta-analysis. Studies are stratified by year of presentation and/or publication. Horizontal bars, 95% confidence interval. NaHCO3 = sodium bicarbonate; NS = normal saline.
Mentions: CIN occurred in a total of 109 patients in the 1,327 patients of the NaHCO3 arms (range 1.4% to 31.0%) compared with 175 such events in the 1,306 subjects treated with NS (range 2.7% to 34.5%) (Table 1). The summary OR was 0.52 (95% CI 0.34–0.81, P < 0.004) (Figure 2) in favor of NaHCO3. The number needed to treat to prevent one CIN was 16 (95% CI 10–34).

Bottom Line: Former meta-analyses and several recent studies have shown conflicting results regarding the protective effect of sodium bicarbonate.No significant differences in the rates of post-procedure hemodialysis (P = 0.20) or death (P = 0.53) was observed.Sodium bicarbonate-based hydration was found to be superior to normal saline in prevention of contrast-induced nephropathy in this updated meta-analysis.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Michigan School of Medicine, Ann Arbor, Michigan, USA. pmeier@med.umich.edu

ABSTRACT

Background: Contrast-induced nephropathy is the leading cause of in-hospital acute renal failure. This side effect of contrast agents leads to increased morbidity, mortality, and health costs. Ensuring adequate hydration prior to contrast exposure is highly effective at preventing this complication, although the optimal hydration strategy to prevent contrast-induced nephropathy still remains an unresolved issue. Former meta-analyses and several recent studies have shown conflicting results regarding the protective effect of sodium bicarbonate. The objective of this study was to assess the effectiveness of normal saline versus sodium bicarbonate for prevention of contrast-induced nephropathy.

Methods: The study searched MEDLINE, EMBASE, Cochrane databases, International Pharmaceutical Abstracts database, ISI Web of Science (until 15 December 2008), and conference proceedings for randomized controlled trials that compared normal saline with sodium bicarbonate-based hydration regimen regarding contrast-induced nephropathy. Random-effects models were used to calculate summary odds ratios.

Results: A total of 17 trials including 2,633 subjects were pooled. Pre-procedural hydration with sodium bicarbonate was associated with a significant decrease in the rate of contrast-induced nephropathy (odds ratios 0.52; 95% confidence interval 0.34-0.80, P = 0.003). Number needed to treat to prevent one case of contrast-induced nephropathy was 16 (95% confidence interval 10-34). No significant differences in the rates of post-procedure hemodialysis (P = 0.20) or death (P = 0.53) was observed.

Conclusion: Sodium bicarbonate-based hydration was found to be superior to normal saline in prevention of contrast-induced nephropathy in this updated meta-analysis.

Show MeSH
Related in: MedlinePlus